Residents of rural areas in Minnesota and across the nation are more likely to have chronic diseases and face hurdles to getting quality care, according to a UnitedHealth Group report that calls for new approaches to rural care.

A study the Minnetonka-based insurer is releasing Wednesday documents an increasingly urgent need to recruit caregivers to less populated outposts and to explore ways that technology can be used to enhance care.

"The reality is rural health care is under pressure," said Simon Stevens, a UnitedHealth vice president and chair of the company's Center for Health Reform and Modernization, which released the study. "Given the number of people coming into health care coverage in the next several years, that pressure is going to increase."

UnitedHealth, the nation's largest insurer by revenue, said it plans to use the report as a way to get public officials to focus on rural issues, improve quality and reduce costs. This is the sixth report from the center, which draws on data from the company's nationwide network of insurance plans.

Regional challenges

The findings echo trends many in the field have tracked for decades, but offer a broad look at key challenges in various regions.

The rural South, also known as the "stroke belt," has a disproportionate share of people with chronic health conditions. The Midwest, a 12-state region that includes Minnesota, has the largest percentage of rural residents and relatively few urban centers.

About 50 million Americans live in rural areas, as do about a quarter of Minnesotans. The study projects that by 2019, about 5 million more rural residents are expected to start receiving Medicaid or some type of other taxpayer-funded program as part of changes in health care laws.

The report says Minnesota is doing a good job of serving rural residents relative to other parts of the country.

"This is old hat to us," said Jim Boulger, a psychologist and professor of family medicine at the University of Minnesota Medical School's Duluth campus, which has been training doctors and looking for ways to improve access to rural and American Indian communities since 1972.

"Rural access has been a national and state problem -- some would say disgrace -- for some time," he said. "While no one in the country comes close to doing what we do, it's not anywhere near solved."

Boulger said about 47 percent of doctors who have trained at the medical school in Duluth now practice in communities with fewer than 20,000 people.

About half are family doctors, he said, a field that is generally less sought out by medical students because it doesn't pay as well as more specialized areas of medicine.

In general, primary care plays a bigger role in rural areas, even though there are fewer than half of the physicians relative to the population as compared with urban areas. UnitedHealth is calling on states to allow broader roles for nurse practitioners and physicians' assistants as a way to deal with a shortage of doctors.

Harnessing the Internet

The study also found that more than half of patients travel more than 20 miles to receive specialty care, with the average person traveling about 60 miles. Expanding the nation's broadband network is crucial to improving care, according to the study, because many illnesses can be handled over the Internet.

Rural caregivers also see more patients with diabetes and high blood pressure, and are more likely to name teen pregnancy and drug abuse as top concerns than their urban counterparts, the study found.

Dr. Christopher Wenner, a solo practitioner in Cold Spring, Minn., southwest of St. Cloud, grew up in Cold Spring and always wanted to go back there.

He said one issue for rural doctors is reimbursement, with lower rates from insurers making medical practice less lucrative than in big cities.

Rural doctors can also face more demands, Wenner said.

"It requires a special skill set to practice in a rural area where you don't have a cardiologist and a gastroenterologist in your back pocket," he said.

Gunnar Birkerts, an internationally acclaimed modernist architect who designed buildings including the Federal Reserve Bank in Minneapolis, the Corning Museum of Glass in Corning, New York, and the University of Michigan Law Library, has died. He was 92.

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